Congestive heart failure and decongestion ability of two different treatments: continuous renal replacement and diuretic therapy: experience of a cardiac step down unit.

Acta cardiologica

PubMedID: 24187761

Spini V, Landi D, Chiostri M, Romano SM, Calabretta R, Gensini GF, Cecchi E, Giglioli C. Congestive heart failure and decongestion ability of two different treatments: continuous renal replacement and diuretic therapy: experience of a cardiac step down unit. Acta Cardiol. 2013;68(4):355-64.
INTRODUCTION
The rehospitalization rate for decompensated heart failure (HF) is high and can be ascribed also to a suboptimal decongestion before discharge. Congestion can be treated with diuretics or continuous renal replacement therapy (CRRT). Aim of this study was to evaluate if diuretics and CRRT, used in agreement to international guidelines, may have a dissimilar decongestion ability in patients with decompensated HF with different baseline characteristics.

METHODS
In 88 patients with HF (NYHA class Ill-IV) we evaluated the effect of CRRT (n = 46) and intravenous diuretics (n = 42) on clinical and instrumental signs of congestion. A clinical score was obtained as the sum of signs and symptoms of HF to estimate the severity of each patient's clinical condition.The choice of diuretics or CRRT was guided by renal impairment or diuretics' resistance.

RESULTS
A significant reduction in clinical HF score was observed in the CRRT group at discharge vs admission (1.3 +/- 1.9 vs 5.7 +/- 2.3, P < 0.001) and in the diuretic group (1.8 +/- 1.4 vs 3.7 +/- 1.6, P < 0.001), while a significant reduction in radiographic signs of pulmonary congestion, pleural effusion, echocardiographic systolic arterial pulmonary pressure (43.41 +/- 13.6 vs 50.5 +/- 20.2 mmHg, P < 0.005) and NT-proBNP (6,676 vs 15,492 pg/ml, P < 0.05) were observed only in CRRT patients. Moreover, also urine output significantly increased only in CRRT patients (1.8 +/- 0.8 vs 0.9 +/- 0.6 ml/h/kg, P < 0.001).

CONCLUSIONS
CRRT and diuretics showed an equivalent ability in relieving clinical signs and symptoms of HF but only CRRT was able to significantly improve several instrumental and biohumoral indicators of congestion.